Medical Weight Loss – Donna Hayek, RD

Medical weight loss is used for people that have a large amount of weight to lose and need a jump start to do it.  Some folks try this first instead of weight loss surgery.  One of the criteria is that they must have a BMI of 30 or higher; which is considered obese.  The idea is to change the behavior of eating healthy and exercising.  “Safe” weight loss is losing 1-2 pounds per week.  This ensures that the weight will stay off rather than losing the weight quickly; which could mean either losing water weight or lean (muscle) mass.  At PLC, we don’t use BMI because we are looking at a person’s lean mass and fat mass, but the drug companies do.  The number on the scale is not always accurate if a person is losing fat and gaining muscle.  A true way to tell is if their clothes are fitting differently (looser) or to obtain muscle and fat mass with a specialized scale or test.  

The weight loss drugs, Ozempic or Mounjaro, are approved for adults with type 2 diabetes.  The drugs called Wegovy or Zepbound are approved for weight loss, but some insurance companies won’t cover the cost of it.  If that is the case, then the person needs to pay out of pocket, which can cost over $1000 for just one month!  The drug is given by the patient as an injection once a week. The drug works by mimicking a hormone called glucagon-like peptide-1 which is produced in the intestines. 


What to expect when starting a medical weight loss program:

Usually, the person is started on the lowest form of the drug and it can be increased every two months or so.  Once your body “gets used to the dose” (by not losing any more weight), the dose can be increased for about another two months and so on.  Once the person is “happy” with their weight, the drug can then be tapered down gradually, just like it was tapered up.  The problem is that once the person is off of the drug entirely, they can start gaining back the weight, so the smart thing to do would be to stay at the lowest dose.  The ultimate goal would be to get off of the drug and continue with “diet” or “healthy eating” and exercise.

The way Wegovy and Zepbound work is they act as a satiety hormone; which makes one feel full quickly, so they are eating less calories; thus, causing weight loss.  The drug also has specific side effects, such as nausea, vomiting and constipation.  Not everyone will get them, but they are worth noting.


How to support medical weight loss through “diet” and portion control:

At PLC, if a patient is prescribed a weight loss drug, the registered dietitian follows the patient for the first few months to ensure that they are following a healthy diet and exercising.  This can be of a form of a phone call or video conference call that lasts about 15-20 minutes.  The RD will start to follow the patient’s food log as soon as they start taking the weight loss drug to see what types of foods and how much calories they are consuming.  This is helpful for a smoother and productive conversation.  The RD will educate the patient on anything they need help with and the patient will have an opportunity to ask any questions they may have.  Recommended for the patient is to also take a multivitamin since they are probably not consuming enough vitamins and nutrients with their lack of calories. Consuming adequate fluids is also important since they might be engaging in more exercise than they previously were. The RD also works together with the doctor and medical assistant to ensure things run smoothly.


Meal plans, how to maintain healthy habits and balance nutrients:

Meal plans can be provided to the patient with foods that they like to consume while making sure the macronutrients and micronutrients are represented.  With the two check-ins, the food diaries are loaded in the database to see how the patient is doing so the RD can fine-tune the information with the patient. It is encouraged that the patient continues logging in their food with a phone app after the sessions with the RD.  This ensures that they will be more successful with their weight loss goals.  This also will show the patient if they are deficient or in excess of any macronutrients or micronutrients so they can fine tune their eating habits.